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Community level factors enabling breast feeding in
South Africa
Presented at the National Breastfeeding Consultative Meeting
22-23 August 2011by Lynn Moeng
Contextual factors
Individual Level- Personal factors Household Level- family influences and
perceptions Community Level- attitudes and support Cultural practices and taboos Knowledge related aspects
Presentation outline
Individual level
Household level
Community level
Macro environment level
Contextual factors that influence breastfeeding promotion in South Africa
Generally, women and caregivers believe that breastfeeding is the best way to feed babies and many do choose breastfeeding as the first feeding option
The questions is why are breastfeeding practices so poor?
Perceptions of caregivers and women about breastfeeding
Not enough milk - Preventable Breast problems - Preventable Baby or Mother too ill - Can be managed Baby crying often Child refuses to breastfeed – many
preventable reasons for this. Fear of HIV transmitting through
breastfeeding Young women believe it is difficult and
painful Going back to work/school - Mothers believe
that children should be introduced to other milks and foods before 6 months, in preparation for separation.
INDIVIDUAL FACTORS
Mother ill/weak
Nipple/breast problem
Child refused breast
Mother working
Chose to formula feed
0 5 10 15 20 25 30
Reason for stopping breastfeeding
Percentages
The need to identify sources of information
Health worker
CHW
Mother
Grand mother
Friend
0 10 20 30 40 50 60 70
Where can one go for support on breastfeeding
Percentages
Family history and traditions- how other children were fed. Storing expressed milk at home is a taboo in our culture. Men not given an opportunity to make decisions on infant
feeding. The best they can contribute is purchasing formula. Influence from grannies The pressure for young girls who have just delivered babies
to go back to school immediately. – the effect of this on the health and survival of these children needs to be investigated.
Preparation for a newborn often includes formula, bottle,teat and self medication eg. Druppels, gripewater and many others.
Family and Household related factors
Link between community structures and the health facility is weak.
Knowledge and skills of community health workers.
Availability and sustainability of support groups
Acceptability of mixed feeding- regarded as the norm.
There are conflicts between cultural norms and information provided by health workers.
Limited utilization of NGO’s to support infant feeding.
Community related factors
Health worker
CHW
Radio
TV
Mother
Grand mother
Friend
Support group
0 10 20 30 40 50 60 70 80 90 100
Where can one go for information on breastfeed-ing
Percentages
Where should women breastfeed- in some environments, restrooms are designated as breastfeeding places- breastfeeding is feeding.
Public places are not breastfeeding friendly
Households are not breastfeeding friendly
Attitudes of the public
Strengthen referral systems from PHC to existing community structures.
Follow-up support just after discharge ( within three days).
How are the postnatal visits used to support breastfeeding.
Role of PHC services
Breastfeeding management challenges◦ Supply and demand◦ Positioning and attachment◦ Assisting mothers with problems such as flat
nipples Growth spurts ( critical points when frequency of
breastfeeding should be increased. Rates of HIV transmission not well understood Feasibility of exclusive breastfeeding for six months Effects of the use of self medication on
breastfeeding including drupples that pored in bath water.
Knowledge: Critical points
Tested strategies that can improve breastfeeding
practices
Partner involvement
Promoting the culture of cup VS bottle feeding
Strategies that can be employed
Improving the knowledge of health workers
Assist mothers to position
Ensuring them that is important to breastfeed twins.
Supporting a mother to
Step 10: Effect of trained peer counsellors on the duration of exclusive breastfeeding
70%
6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Project Area Control
Per
cent
age
Exclusivelybreastfeeding 5month old infants
Adapted from: Haider R, Kabir I, Huttly S, Ashworth A. Training peer counselors to promote and support exclusive breastfeeding in Bangladesh. J Hum Lact, 2002;18(1):7-12.
Slide 4.10.5
Slide 4.2.5
12.7
58.7
6
56.8
72 75
0
20
40
60
80
100
Brazil '98 Sri Lanka '99 Bangladesh '96
Exc
lusi
ve b
reas
tfee
din
g (%
)
Control
Counselled
Step 2: Breastfeeding counselling increases exclusive breastfeeding
All differences between intervention and control groups are significant at p<0.001.From: CAH/WHO based on studies by Albernaz, Jayathilaka and Haider.
Age:
(Albernaz) (Jayathilaka) (Haider)
2 weeks after diarrhoea treatment
4 months3 months
Exclusive breastfeeding for 6 months is possible if we have health care workers who support mothers
45% 72.5%
66.7%
81.90%
0
20
40
60
80
100
6 weeks 3 mths 5 mths 6 mthsAge
% e
xclu
sive
ly b
reas
tfee
ding
Median duration of exclusive
breastfeeding = 159 days
Coovadia et al., Lancet 2007
Home visits improve exclusive breastfeeding
80%
67%62%
50%
24%
12%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
2 weeks 3 months
Infant's age
Exc
lusi
ve
reas
tfee
din
g
(%)
Six-visit group
Three-visit group
Control group
From: Morrow A, Guerrereo ML, Shultis J, et al. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet, 1999, 353:1226-31
Slide 4.10.6
Capacity building of CHW Improve prenatal and post natal education Involvement of all role players in promoting
Breastfeeding Investment in marketing Social mobilisation of community Creating conducive environments for
mothers to breastfeed
What needs to be done
Thank you